HOSPITAL PLANNING AND DESIGN Smriti Singh


Smriti Singh, MD of Symbi Consulting, has over 20 years’ experience providing strategic advice and delivering change and transformation programmes in the health sector. She specialises in developing vision and strategy for new developments, coordinating and authoring business cases, leading senior stakeholder engagement, and supporting client- side co-ordination and monitoring, ‘to enable delivery of true transformation’. Smriti has designed


and run numerous clinical engagement sessions, workshops, and training programmes, for NHS teams. A ‘thought-leader’, she has published on healthcare strategy, including the future of hospital buildings, and is passionate about transformation of healthcare, and bringing about more integrated models.


Two areas with major room for improvement The Nuffield Trust’s report, Lessons learned from the last hospital building programme and lessons for the next,6 argues that the two areas of the end-to-end capital project process where we can do much better are (1) approvals and (2) quality of design. Both can be significantly improved by smarter, and more targeted, involvement of clinicians. That clinical engagement matters is backed up by a study in the British Journal of Nursing which shows that clinical engagement in procurement has a positive impact on take-up of products and eventually savings.7 Getting the right clinical input, at the right time, is vitally important when developing a new facility. Utilising an Expert Network allows for this to be done in a way that is more effective and efficient, with the following benefits: n Crucially, we differentiate between clinical input and clinical engagement. Clinical input is needed to address specific questions, and is provided by specialists who may not be employees of the hospital. Our ‘Experts Network’ provides specialist input, where it is appropriate. In contrast, clinical engagement is with people who work within that organisation.


n While we still need senior level sign-up from the start, where specific clinical input is needed, this can often be obtained more efficiently from our Experts Network.i


n Drawing on external experts to provide clinical input has a particular advantage at the early stages of a project, when funding may be uncertain. It means we avoid taking up unnecessary staff time and creating uncertainty and concern amongst hospital staff. It also enables us to rapidly use specific knowledge and current best practice, and deliver more value for money, including exploring the latest clinical models.


n One-off clinical input, in the form of very specific questions from external experts, is also helpful at later stages of the design and construction phase, including specialist equipping, which is often overlooked.


Report on the PFI hospital programme The Nuffield Trust report on PFI hospitals from the 1990s to early 2000s states that, despite clinical engagement, ‘there was a lack of knowledge about the clinical models available’. Due to the current demands on staff we recognise


that not all clinicians can or want to step away from their busy, intellectually and emotionally demanding day jobs to support a capital project. We believe that identifying engaged and committed Trust staff is essential, however,


and supporting them with external specialists via our Experts Network enhances the engagement process for everyone involved. To rapidly obtain the input needed by designers and other technical professionals, and to do it efficiently, Experts Network clinicians: n are fully qualified and experienced – that is a given; n have a set of shared values, and exhibit highly collaborative behaviours;


n bring a base level of understanding of capital projects.ii


Curious and receptive to change The people in our Experts Network are all passionate about improving healthcare; they are curious, interested, and respect others’ expertise; they are open to change, new ideas, and perspectives. Our Experts Network consists of specialists across the full spectrum of healthcare professionals – from strategists through to individual clinical specialisms, all intrinsically integrated with significant capital projects. In terms of ways of working, our Experts Network are collaborative, friendly, and approachable; they are prepared to share their expertise and experience, and they are honest, independent, and courageous. The last point is particularly important, as external clinicians may be needed to provide constructive clinical challenge, and this is not an easy thing to do. While it’s arguable that all clinicians should adhere to these values and behaviours, this is something our experts sign up to. While external clinicians’ input is highly effective, particularly at the very early stages of a project, local engagement – with clinicians who are employees of the hospital being (re)developed – is also critical, especially when it has a clear purpose and is carefully managed. In contrast to clinical input, clinical engagement serves a different purpose. Engagement with the hospital’s clinicians is about providing more than answers to designers and engineers’ questions. It is to ensure that the development supports delivery of the Trust and system’s wider strategy, which may include moving to different models of care, and to ‘socialise’ the idea of the new development, i.e. to disseminate information about the development across the workforce, and help communicate how the project enables the hospital and the wider system’s overall strategy. This is not to say that clinical engagement with a


hospital’s clinical staff is not an opportunity to obtain expert input. Rather, the input obtained during this type of engagement is about the hospital staff’s ways of working and preferences, specific to their site, and in relation to other local services within their particular health and care system. With the traditional approach to clinical engagement,


staff have reported that the experience is unsatisfactory, and that the outcomes often don’t quite meet their needs, but why is this? For many reasons, key being often that the right questions are framed in a manner unfamiliar to the client which they find difficult to interpret and respond to, leading to the information shared being sub-optimal, and the engagement stressful for all concerned. Moreover, with clinicians’ time now more pressured, securing Trust staff time to develop future models of care and the associated built environment is harder, and – when provided – staff can be distracted with the ‘fire-fighting’ of the day.


The Nuffield Trust’s report, Lessons learned from the last hospital building programme and lessons for the next, argues that the two areas of the ‘end-to-end capital’ project process where ‘we can do much better’ are approvals and quality of design. The authors of this article say both can be significantly improved ‘by smarter, and more targeted’, involvement of clinicians.


64 Health Estate Journal April 2025


AdobeStock / Rido


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68